Thursday, February 3, 2011

Health In The Headlines: On Forcing Americans To Buy Insurance

"A second federal judge ruled on Monday that it was unconstitutional for Congress to enact a health care law that required Americans to obtain commercial insurance, evening the score at 2 to 2 in the lower courts as conflicting opinions begin their path to the Supreme Court."

The provision in President Obama's health care bill referenced in the above quotation is set to go into effect in 2014. Republican-appointed Judge Roger Vinson, who made the ruling, also found the rest of the health care bill unconstitutional. The whole matter is surely destined for the U.S. Supreme Court, as the Times article suggests.

I don't pretend to be a constitutional scholar. So I don't feel I can comment on the "constitutionality" of the health care bill, nor on the specific provision requiring all Americans to purchase commercial insurance. Nor do I want to get into a debate regarding party politics. Those of you who know me know where I stand politically, and this blog post is by no means a political party statement. So don't even go there.

That said, I have an opinion on the efficacy of the health care insurance provision, based on my own experiences working in the medical field.

First of all, I believe all Americans deserve proper health care. In our convoluted health care system, that means (most likely) having insurance of some sort, be it individually-purchased insurance, or government-provided insurance. But forcing people to buy insurance on their own dime is another matter. Here is why I think that is a problem.

I work at a free clinic in Chicago where the only requirement to be a patient is that you have absolutely no insurance. That means no private insurance, no Medicare, no Medicaid. This clinic is for the people who fall through the cracks: the people who can't afford insurance on their own and who don't qualify for government assistance, either because they are undocumented immigrants or because they don't meet the income "poverty" requirements the government sets forth. I don't know exactly how many patients the clinic has, but I do know that the extensive filing system in the clinic's office is full to bursting, and that doctors and nurse practitioners do new intake appointments every day. There is clearly a need for this type of service in the Chicago community.

But these people, who are people, let's not forget, not numbers, nor statistics on a chart, do not come to this clinic by choice. They are there because they need this service. Because many of them can barely afford the basic necessities of daily living, such as food, electricity, the bus fare to get to work (if they are lucky enough to have a job -- probably a minimum wage one -- at all).

Asking them, nay forcing them to buy health insurance (or face a penalty), is forcing many of them to give up something else that they desperately need. Food, electricity, the bus fare to get to work. The list goes on.

While the government is planning to expand Medicaid eligibility (according to the same NY Times article), I doubt very much whether that supposed "safety net" will safely catch all of these people.

This provision of the health care bill is well intentioned, I understand that. It is meant to make sure that people receive health care when they need it, and don't wind up with enormous out-of-pocket expenses when some horrible illness strikes. The formation of "health care exchanges" is also meant to drive down rates for people who have to purchase insurance on their own. Those are obviously good goals, and I support them.

But what has not been taken into account is that there are scores of people who literally cannot afford even $25 a month per person in their family for health insurance. I have met many of them. And I cannot, in good conscience, support such a provision.

Constitutional? I have no idea. Conscientious? Not according to my experience in the real world. And that, I believe, is what many politicians lack: real-world experience. Or at the least, they are so far removed from it that they have forgotten what it's like out there in the real world. And that's just plain sad.

1 comment:

People who don't earn any money will not be forced to purchase insurance, the same as people who don't earn money aren't subject to paying Social Security taxes.

This whole idea of the individual mandate stems from trying to make pre-existing conditions limiting your access to insurance a thing of the past. If you think about it, it makes sense; insurance companies could not deny these people, thus they would have to offset the risk of this pool by offering high priced insurance. If we instead "mandate" that everyone obtain insurance, sickly and healthy alike, the costs are "re-distributed" across the entire pool, or so they should be in theory.

What this law ultimately is, however, is government stepping in to regulate what is essentially a natural monopoly: there are economies a company must achieve in order to operate as a health insurer and remain healthy, and able to cover their liabilities. The natural course for this industry is consolidation. This is why the industry is so bent out of shape about it; blockbuster profits will before a thing of the past.

Charles Fried, during the Senate Judiciary Committee hearing about the Constitutionality of this law, said that had the government offered a public option instead of this law, that would have been absolutely Constitutional, no doubt about it. So he is amazed that the current Administration offering a private market route is being so heavily lambasted.